Biomedical subjects

R D Hilgers

Publications and source records attributed to R D Hilgers.

At least 37 records · Page 2Linked to original sources

PubMed1996

Sleep apnoea in treated acromegaly: relative frequency and predisposing factors.

OBJECTIVES: Sleep apnoea is common in active acromegaly. It is associated with increased morbidity and mortality but can be treated effectively. The objective of this study was to determine the largely unknown relative frequency of, and the predictive factors for, sleep apnoea in treated acromegalic patients. DESIGN: Retrospective cohort study. SETTING: Tertiary referral hospital. PATIENTS: Fifty-four of 100 patients with treated acromegaly. If sleep apnoea had been diagnosed before acromegaly, the patient was excluded. MEASUREMENTS: Sleep studies (using the MESAM-4 device measuring oxyhaemoglobin saturation, heart rate, snoring sounds and body position to determine presence and severity of sleep apnoea); GH and IGF-I levels; body mass index, neck and index-finger circumference; daytime symptoms of sleep apnoea, duration of acromegaly before treatment, shoe and neck-size difference since beginning of acromegaly; age, sex and treatment modes of acromegaly. RESULTS: The relative frequency of sleep apnoea was 39% in the 54 patients with sleep studies and at least 21% in the entire study population of 100 patients. In patients with sleep apnoea, statistically significant higher values were observed for GH (P = 0.002), IGF-I (P = 0.029), age (P = 0.014) and neck circumference (P = 0.016). An index-finger circumference of > or = 8.5 cm was associated with a significantly higher desaturation index (P = 0.012, Mann-Whitney U-test). Adenomectomy had been performed significantly less frequently in patients with sleep apnoea (P < 0.001, X2 test). The body mass index was non-significantly higher in the patients with sleep apnoea. CONCLUSIONS: The relative frequency of sleep apnoea in patients with treated acromegaly is at least 21%. Parameters of predictive value for the presence of sleep apnoea in this population are neck and index-finger circumference as measures of soft tissue hypertrophy, age, GH and IGF-I levels, and whether or not operative therapy was applied.

Acromegaly↗

PubMed1996

Fosinopril improves regulation of vascular tone in mesenteric bed of diabetic rats.

Because diabetes mellitus leads to vascular dysfunction, we examined the microvascular endothelial and smooth muscle function in long-term diabetes and a possible influence of fosinopril treatment (10 mg/kg). We investigated isolated perfused mesenteric beds of diabetic rats (4 groups: control, control + fosinopril, diabetes, diabetes + fosinopril; diabetes of 6-month duration, induced by streptozotocin, STC) were investigated using computer-assisted microvideoangiometry. Vascular diameter of four different vascular regions [classified as conductive (G1, 303 +/- 6.5 mu m and G2, 239 +/- 6.3 mu m) and resistance (G3, 192 +/- 4.5 mu m and G4, 124 +/- 2.6 mu m) vessel generations; resting conditions, control group] were increased in diabetes by approximately 20%. However, the endothelium-dependent relaxation in response to 1 mu M acetylcholine (ACh) was reduced from 38-44% to 20-25% (diabetes mellitus) with maximal impairment in G4 vessels. This could be significantly antagonized by fosinopril treatment. Similarly, vasodilation in response to 1 mu M glyceroltrinitrate (GTN) was reduced from 50-58 to 20-30%, but was partially prevented by fosinopril (32-38%), whereas potassium chloride (KCl)-induced vasoconstriction did not show differences between the groups. Inhibition of nitric oxide (NO) synthesis by 3 mu M L-NG-nitro arginine (L-NNA) resulted in a slight vasoconstriction of all vessels (12-25%), with maximum response in G3/G4. This was not altered by disease or treatment. We conclude that (a) long-term diabetes leads to endothelial and smooth muscle dysfunction with reduced capability of vasodilation and either an impairment of NO release or a reduced smooth muscle responsiveness to and (b) a predominant impairment of NO-dependent regulation in small resistance vessels, and (c) that fosinopril treatment can at least partially prevent this vascular dysfunction.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1996

False positive malignant peritoneal cytology and psammoma bodies in benign gynecologic disease.

OBJECTIVE: To determine the incidence of false positive malignant peritoneal cytology and psammoma bodies associated with benign gynecologic disorders. STUDY DESIGN: Pelvic peritoneal fluid was prospectively collected for cytologic examination from 119 women undergoing laparoscopy for benign conditions (infertility, 67; pelvic pain, 35; elective sterilization, 17). The median age was 30. No patient had laparoscopic gross cancer or histologic evidence of cancer. RESULTS: The peritoneal cytology of 2 of 119 cases (2%) contained cells with features suggestive of malignancy, and 6 of 119 cases (5%) contained psammoma bodies. Both cases of false positive peritoneal cytology and four of six with psammoma bodies were associated with endometriosis. All cases were followed for a minimum of two years, and no patient had developed cancer. CONCLUSION: Peritoneal fluid from cases of benign gynecologic disorders, especially endometriosis, can contain psammoma bodies and cells suggestive of malignancy.

Adult↗

PubMed1995

Conservative management of chemotherapeutic-induced thrombocytopenia in women with gynecologic cancers.

During the course of four recent dose-intense chemotherapy trials, the routine practice of transfusing patients with platelet counts < 20,000/microliters was changed to a more conservative style of management limiting prophylactic transfusions to patients with platelet counts < 5000/microliters. One hundred seventy-nine episodes of thrombocytopenia in 46 patients enrolled in four dose-intense chemotherapy trials were evaluated. Thirty-two patients had advanced carcinoma of the ovary, 10 had pelvic sarcomas, and 4 had cervical cancer. Of the 179 episodes of thrombocytopenia evaluated, 100 exhibited severe thrombocytopenia (platelet count < 20,000/microliters). Of these 100 episodes, 30 received prophylactic platelet transfusions while 70 did not. Thirty-eight episodes of thrombocytopenia were 5000-10,000/microliters, 24 of which received prophylactic platelet transfusions while 14 did not. Eighteen episodes (10%) of thrombocytopenia resulted in minor bleeding and all occurred during severe thrombocytopenia. Minor bleeding occurred in 27% of episodes of severe thrombocytopenia receiving prophylactic platelet transfusions versus 14% not transfused (P = 0.2). Of the 38 episodes of thrombocytopenia 5000-10,000/microliters, minor bleeding occurred in 17% receiving prophylactic platelet transfusions versus 24% not transfused (P = 0.95). None of the 179 episodes of thrombocytopenia resulted in major bleeding, including 70 episodes of thrombocytopenia < 20,000/microliters not receiving prophylactic platelet transfusions which included 14 episodes of thrombocytopenia between 5000-10,000/microliters. In conclusion, in women with gynecologic cancer and chemotherapy-induced thrombocytopenia, we safely limited prophylactic platelet transfusions for episodes of thrombocytopenia < 5000/microliters. We hope our study will prompt prospective, randomized trials evaluating the need of prophylactic platelet transfusions for chemotherapy-induced thrombocytopenia in patients with solid tumors.

Adult↗

PubMed1995

Cisplatin, 5-fluorouracil, and ifosfamide in the treatment of recurrent or advanced cervical cancer.

We performed a prospective, phase II trial of cisplatin, 5-fluorouracil, and ifosfamide in the treatment of 30 women with recurrent or advanced cervical cancer. Median age was 47 years old. Twenty-one tumors were squamous and 83% of tumors were grade 2 or 3. Twenty-six patients (87%) received prior pelvic radiotherapy, and six patients (20%) received prior radiation sensitizing chemotherapy. Median time to recurrence was 6 months. In 11 patients (37%) tumor recurred in the pelvis. A combination of cisplatin 90 mg/m2, 5-fluorouracil 1500 mg/m2, and ifosfamide 3 g/m2 was administered intravenously in divided doses over 3 consecutive days every 28 days. Sixteen patients (53%) responded to chemotherapy with a complete response occurring in 5 patients (17%) and a partial response in 11 patients (36%). One of 11 patients (7%) with a pelvic recurrence responded compared to 15 of 19 (79%) with extrapelvic recurrence (P = 0.001). Tumors recurring after 6 months had a higher response rate (73%) compared to those recurring before 6 months (33%) (P = 0.05). Three of the six patients (50%) treated with prior radiation sensitizing chemotherapy responded. Seven of nine patients (78%) with adenocarcinoma responded. Median survival is 12 months (3-36 months). In conclusion, cisplatin, 5-fluorouracil, and ifosfamide resulted in a favorable response rate (53%) and a median survival of 12 months. As expected, patients with extrapelvic recurrence and recurrence after 6 months had an improved response rate while, surprisingly, those receiving prior radiation sensitizing chemotherapy and those with adenocarcinoma did not exhibit a less favorable response rate.

Adenocarcinoma↗

PubMed1995

Loop electrosurgical excision procedure for intensified cytoreduction of ovarian cancer.

The objective was to evaluate the loop electrosurgical excision procedure (LEEP) for intensified cytoreduction of ovarian cancer. Twenty consecutive women with residual epithelial ovarian cancer following maximum cytoreduction by standard surgical techniques were treated with LEEP-intensified cytoreduction. LEEP was employed to resect metastases involving intestines (18 patients), diaphragm (3 patients), liver (6 patients), spleen (3 patients), and peritoneal surface (18 patients). Median LEEP time was 9 min (range 3-27 min). Blood loss secondary to LEEP was minimal with no patient experiencing bleeding > 20 ml. Following LEEP-intensified cytoreduction, 17 of 20 patients (85%) had no gross residual disease. Seventeen of 18 patients (94%) had all intestinal metastases resected. All superficial liver (6 patients) and splenic metastases (3 patients) were completely resected. Peritoneal metastases were completely resected in all 18 patients. No patient experienced a complication directly related to LEEP. LEEP can be performed rapidly, with minimum blood loss, and results in intensified cytoreduction with minimal morbidity.

Adult↗

PubMed1995

[The force transmission of positioners in different degrees of incisor protrusion. An in-vitro study].

The purpose of this study was to examine the forces exerted on protruded upper incisors by tooth positioners. Methodologically an in vitro force measurement model was used. The tooth positioners were made of 7 readily available materials commonly used in orthodontics. The study found that the values of the forces, which ranged from 0.4 N to 14.0 N per tooth, are dependent on the material used and the degree of tooth protrusion. In addition, the study analyzed the changes in force over a 3-month period during which time the positioners were stored at 37 degrees +/- 1 degree C in an aqueous environment. This environment corresponds closely to that found in the mouth.

Dental Articulators↗

PubMed1995

Fluoride retention of incipient enamel lesions after treatment with a calcium fluoride varnish in vivo.

The aim was to determine the fluoride retention in plaque-covered and clean incipient enamel lesions after topical application of a CaF2/NaF varnish (Bifluorid 12). In 50 specimens of bovine enamel an incipient lesion was produced with acidic hydroxyethylcellulose (pH 4.8; 72 h). 40 specimens were fluoride varnished; the 10 remaining specimens were used for measuring baseline fluoride content. Each six of the fluoridated specimens were recessed in the buccal aspects of an intraoral appliance worn for 5 days. During the experimental period one side of the appliance was kept clean, and plaque growth was allowed on the other. KOH-soluble and structurally bound fluoride were determined immediately, 1 day, 3 days and 5 days after fluoridation, and compared with the baseline fluoride content of the enamel. Immediately after fluoridation, a considerable amount of KOH-soluble fluoride was bound, but after 5 days 80% had been lost. Simultaneously a significant increase of non-KOH-soluble or structurally bound fluoride was detected in both plaque-covered and clean enamel. It is evident that this CaF2/NaF varnish deposits more KOH-soluble fluoride on the surface of demineralized enamel than other varnishes, but after 5 days fluoride retention is similar to that from other varnishes.

Analysis of Variance↗

PubMed1995

Plaque surface area after rinsing with a low-level fluoride-containing Darjeeling tea.

Plaque surface area after rinsing with a tea, containing low levels of fluoride, was evaluated in 30 human volunteers with a single-blind, one-operator, three-period, three-treatment cross-over study. The mouthwashes employed were: (1) tea (Darjeeling first flush:< 0.2 ppm F-), (2) Meridol(R), (3) control (tap water:< 0.2 ppm F-). During the experiment the participants refrained from oral hygiene procedures and rinsed their mouth three times a day after each meal with 20 ml of the respective rinse. After 3 d standardized photographs were taken of the upper canines and premolars and the plaque areas were measured planimetrically. Statistical analysis showed a marked decrease in plaque surface area after rinsing with Meridol, whereas no difference in plaque surface area was observed after mouthrinsing with tea and tap water, respectively.

Adolescent↗

PubMed1995

[Long-term roentgenologic follow-up of asymptomatic impacted wisdom teeth in former orthodontic patients].

Long-term follow-up of orthopantomographs of 251 adults orthodontically treated former patients showed 113 clinically asymptomatic impacted 3rd molars in 58 patients. Radiographic assessment revealed contact of impacted 3rd molars with the 2nd molars, resorption of upper and lower 2nd molars, reduced bone height on the distal side of the maxillary and mandibular 2nd molars, as well as pathologically widened pericoronal spaces of the upper and lower 3rd molars. The comparison of the sagittal 3rd molar position in 52 impacted teeth revealed a sagittal change in all 3rd molars from post-treatment to follow-up: maxillary and mandibular 3rd molars had rotated to a more upright position and showed an increase in mesio- or distoangulation or a change of axial inclination. The lack of predicting factors such as age, period of impaction, extent of space deficiency, developmental stage, level of eruption, and bone conditions leads the authors to recommend that former orthodontic patients be recalled at regular intervals for assessment of changes in the condition and position of erupting or impacted 3rd molars.

Adult↗

PubMed1994

Surgical stapling technique for radical hysterectomy.

We developed a new technique for performing radical hysterectomy using surgical staplers. An endoscopic stapler was used to transect the uterosacral and cardinal ligaments and a roticulating stapler with absorbable staples was used to transect the vaginal cuff. Fifteen consecutive patients with primary stage IA2 or IB cervical carcinoma underwent class III radical hysterectomy using the new stapling technique and were compared to the previous 15 consecutive similarly staged patients who underwent class III radical hysterectomy by the traditional clamp, cut, and suture ligation technique. Median operative time for the stapler group was 3 hr (1.3-4 hr) versus 4.3 hr (2.5-5.8 hr) for the traditional technique (P = 0.0002). Estimated blood loss for the stapler technique was 650 ml (200-1200 ml) versus 1100 ml (450-2600 ml) for the traditional technique (P = 0.009). Three patients (20%) received transfusions in the stapler group versus 10 (67%) in the traditional group (P = 0.05). There was no difference in the rate of infections, venous thrombosis, lymphocysts, fistuli, bladder atony, or obstipation between the two groups. At a median follow up of 22 months, only one patient has recurred (from the traditional group). In conclusion, the surgical stapling technique of radical hysterectomy does not appear to adversely affect survival or increase complications while operative blood loss and operative time are significantly reduced.

Adult↗

PubMed1994

A long-term, follow-up, radiographic evaluation of asymptomatic impacted third molars in orthodontically treated patients.

Long-term follow-up orthopantomographs of 251 adult orthodontically treated former patients showed 113 clinically asymptomatic impacted third molars in 58 patients. Radiographic assessment revealed contact of impacted third molars with the second molars, resorption of maxillary and mandibular second molars, as well as pathologically widened pericoronal spaces of the maxillary and mandibular third molars. The comparison of the sagittal third molar position in 52 impacted teeth revealed a sagittal change in all third molars from post-treatment to follow-up: maxillary and mandibular third molars had rotated to a more upright position and showed an increase in mesio- or distoangulation or a change of axial inclination. The lack of predicting factors such as age, period of impaction, extent of space deficiency, developmental stage, level of eruption, and bone conditions leads the authors to recommend that former orthodontic patients be recalled at regular intervals for assessment of changes in the condition and position of erupting or impacted third molars.

Adult↗

PubMed1994

Carboplatin, etoposide, and ifosfamide as second-line treatment for ovarian cancer.

A total of 25 patients with epithelial ovarian cancer were treated with second-line carboplatin, etoposide, and ifosfamide (ICE) following failure of first-line cisplatin-based combination chemotherapy. The combination carboplatin 35 mg/m2, etoposide 50 mg/m2, and ifosfamide 1,200 mg/m2 was administered intravenously daily for 3 consecutive days. Response was seen in 13 patients (52%) with 7 complete responses (28%) and 6 partial responses (24%). Median duration of response was 9+ months (range: 4-17+ months). Response rate to second-line ICE relates directly to prior response to first-line cisplatin-based chemotherapy: 12 patients (67%) responded to second-line ICE who responded to first-line cisplatin-based chemotherapy, while only 1 patient (14%) responded who progressed on first-line cisplatin-based chemotherapy. Median survival was 18+ months (range: 2-31+ months). There were six episodes (4%) of grade 4 neutropenia, seven episodes (4%) of grade 4 thrombocytopenia and no grade 3 or 4 nonhematologic toxicity. ICE has moderate activity with minimal toxicity as second-line treatment of advanced epithelial ovarian cancer.

Adult↗

PubMed1994

Ondansetron and metoclopramide fail to prevent vomiting secondary to ultra-high-dose cisplatin-carboplatin chemotherapy.

OBJECTIVE: To determine the severity of emesis caused by ultra-high-dose cisplatin-carboplatin chemotherapy and to compare the antiemetic efficacy of an ondansetron regimen and a metoclopramide regimen. METHODS: Forty consecutive patients with stage III or IV epithelial ovarian cancer or advanced or recurrent endometrial cancer were treated with ultra-high-dose cisplatin-carboplatin chemotherapy. No patient had received prior chemotherapy. Chemotherapy consisted of intravenous (IV) cisplatin 70 mg/m2 and IV carboplatin 100 mg/m2 administered on days 1 and 8 every 28 days for five cycles, representing a total monthly organoplatin dose of 207 mg/m2. Patients were randomized to receive metoclopramide, diphenhydramine, prochlorperazine, and lorazepam; or ondansetron, dexamethasone, prochlorperazine, and lorazepam. Patients were blinded and there was no crossover. The metoclopramide dose was 2 mg/kg IV every 2 hours x 3, and the ondansetron dose was 0.15 mg/kg IV every 4 hours x 3. RESULTS: All 40 patients developed vomiting; 21 (52%) developed severe vomiting and seven (17%) required home IV therapy (grade 4). Eight patients (40%) receiving the metoclopramide regimen developed severe vomiting, compared to 13 (65%) in the ondansetron group (P = .50). Two patients (10%) in the metoclopramide group developed grade 4 vomiting, compared to five (25%) in the ondansetron group (P = .45). Except for sedation and amnesia, there were no significant side effects associated with either regimen. CONCLUSION: Neither regimen was effective in preventing high-dose cisplatin-carboplatin-induced emesis, and the ondansetron regimen did not appear to be superior.

Aged↗

PubMed1994

Postthaw viability of frozen human ovarian cancer tumor specimens.

Thirty-five human ovarian cancer tumor specimens were frozen by both rapid freeze and slow freeze with dimethyl sulfoxide (DMSO) to determine which method results in optimal postthaw viability. Median viability following a rapid freeze was 8% as compared to 90% with slow freeze with DMSO (P = .0001). Eighty-seven percent of tumors had a viability of > 80% following slow freeze with DMSO. When experimentation on human ovarian cancer tumor cells requires postthaw viability, we recommend slow freeze with DMSO.

Carcinoma↗

PubMed1994

Particle concentration fluorescence immunoassay chemosensitivity assay for human epithelial ovarian cancer.

We adapted particle concentration fluorescence immunoassay technology to develop a new chemosensitivity assay. Six human epithelial ovarian cancer cell lines were incubated with cisplatin for 24 hours. Cells were then labeled with a fluorophore for 30 minutes. Removal of supernatant, washing of tumor cells, and reading of epifluorescence was performed automatically. Percent cell lysis was calculated simultaneously by chromium release assay. The particle concentration fluorescence chemosensitivity assay detected cell lysis in all six cell lines. The chemosensitivity assay detected a larger percent lysis than the chromium release assay in each of the cell lines. The advantages of our chemosensitivity assay are plating efficacy, speed, efficiency, safety, and accuracy.

Cell Death↗

PubMed1994

False-positive malignant peritoneal cytology associated with pelvic endometriosis.

The peritoneal washings obtained at diagnostic laparoscopy of two women with suspected endometriosis contained cells with cytologic features of adenocarcinoma. Exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic washings confirmed endometriosis with no evidence of cancer. At 1.5-year and 4.0-year follow-up, respectively, cancer had not developed in either patient. The authors report what they were able to find in the literature regarding false-positive assessments of malignancy obtained by cytologic examination. They also outline steps to be taken should a diagnosis of malignancy arise in a woman with endometriosis who desires pregnancy.

Adenocarcinoma↗

PubMed1993

High-dose-rate brachytherapy in primary stage I and II vaginal cancer.

Thirteen patients with primary vaginal cancer were treated with external beam irradiation and high-dose-rate brachytherapy. Median age was 65 years old. Five tumors were stage I, 4 stage IIA, and 4 stage IIB. Twelve tumors were squamous and 11 were moderately or poorly differentiated. Median tumor diameter was 4 cm. Patients were treated with external beam irradiation (4500 cGy) and high-dose-rate brachytherapy (2000-2800 cGy in three to four fractions). All 13 patients had a complete response. Local control was achieved in 12 patients (92%) at a median follow-up of 2.6 years. No acute or chronic intestinal or bladder grade 3 or 4 toxicity was observed. Moderate to severe vaginal stenosis occurred in 6 patients (46%). Treatment of stage I and II primary vaginal cancer with external beam irradiation and high-dose-rate brachytherapy appears to produce a high response rate, local control, and survival with minimal complications.

Adult↗